视盘RNFL厚度改变与视野缺损的关系

Relationship between Changes in RNFL thickness of optic discs and visual field defects

目的探讨视网膜神经纤维层厚度与视野的关系及其在司法鉴定中的应用。方法采用GDx VCC和Octopus自动视野计对外伤视神经病变52例进行检查。按照视野有效值分组(组1-重伤组,组2-轻伤组,组3-轻微伤及以下组),统计其平均RNFL厚度,对各组的RNFL厚度进行方差分析;同时对平均RNFL厚度与视野指数(MD、MS、sLV)、视野有效值进行相关性及回归分析。结果组1的RNFL平均值36.300±8.456 95μm,组2的RNFL平均值53.647 4±15.453 06μm,组3的RNFL平均值60.903 6±9.535 14μm。通过方差分析,组1~3各组间差异显著,各组两两相比较差异显著。平均RNFL厚度与视野有效值、MS呈正相关(r=0.543、0.400,P<0.05),平均RNFL厚度与MD、sLV呈负相关(r=-0.450、-0.440,P<0.05)。平均RNFL厚度与视野有效值、MD、MS、sLV的直线回归方程分别为Y=0.967X+19.508、Y=0.095X-10.858、Y=0.175X+9.187、Y=-0.205X+20.215;二次项方程分别为Y=-0.037X^2+5.208X-93.795、Y=0.010X^2-1.325X+50.111、Y=-0.008X^2+1.103X-15.606、Y=0.004X^2-0.520X+22.232。结论 RNFL厚度检测具有客观评定视野的法医学价值,有望成为评估视野的一种客观、形态学新方法。

Objective To discuss the relationship between thickness of RNFL and visual field, and its application in forensic identification. Methods Using the GDx VCC and Octopus automatic perimeter to check on 52 optic nerve lesion cases. The data is grouped according to valid value of visual field（Group1-severe injury group, Group2-minor injury group, Group3-slight and following slight injury group）, calculated for the averaged RNFL thickness, and analyzed by ANOVA. Meanwhile, the correlation between RNFL thickness and visual field indices（effective value of visual field, MD, MS, sLV） was analyzed with Pearson＇s correlation and described in scattered plot. Results Group 1 to 3 average RNFL thickness was 60.903 6±9.535 14μm, 53.647 4±15.453 06μm, 36.3±8.456 95μm accordingly. Through ANOVA we can see that differences wer significant between every group. The valid value of visual field and MS were positively with the average RNFL thickness with a correlation of 0.543, 0.400, respectively（P〈0.05）. The MD and sLV were negatively correlated with the average RNFL thickness with correlation-0.450、-0.440, respectively（P〈0.05）.Linear relationship between the average RNFL thickness and effective value of visual field, MD, MS, sLV were Y=0.967X＋19.508, Y=0.095X-10.858, Y=0.175X＋9.187, Y=-0.205X＋20.215 accordingly. Nonlinear relationship between the average RNFL thickness and effective value of visual field, MD, MS, sLV were Y=-0.037X^2＋5.208X-93.795, Y=0.010X^2-1.325X＋50.111, Y=-0.008X^2＋1.103X-15.606, Y=0.004X^2-0.520X＋22.232. Conclusion RNFL thickness measurement is expected to be an objective assessment in visual field, a new morphological methods.